Surgical skill, a sum of acquired knowledge, deliberate practice, and experience, is associated with improved patient outcomes [10]. This skill is best acquired with structured constructive support. [11] This yESTES-led inquiry delved into mentorship accessibility across Europe, canvassing insights from 123 visceral trauma, skeletal trauma, and emergency general surgeons, ESTES members, in 20 countries. Most respondents confirmed mentorship encounters, albeit with mixed experiences and scant formal supports. The study spotlighted particularly at-risk groups. Trainees, particularly female surgeons, are disadvantaged by mentorship voids. Key areas for enhancement emerged, emphasizing NTS mentorship and surgical societie’s potential roles in mending the mentorship breach, proposing both short and long-term plans for surgical trainees and those new to practice (Table 2).

Peer guidance, as evidenced by the Association of Surgeons of Great Britain and Ireland’s Early Years Career Consultant Network, is emerging as a novel mentorship model, transcending traditional mentor–mentee dynamics, and offering a mutual support network which can significantly enhance early-career experiences [12, 13]. Young ESTES mirrors this initiative, fostering education and collaboration among Europe’s emergent emergency and trauma surgeons. Leveraging social networks and digital platforms for knowledge exchange has proven invaluable, as initiatives like Surgical Pizza and Behind The Knife [14, 15]. However, the effects of such peer mentorship on career development trauma and emergency surgery require future longitudinal investigation.

Many ESTES survey participants reported mentor interactions, aligning with findings from the UK and Canada, where structured programs have been noted to foster successful mentor–mentee matches [16, 17]. Similar trends were observed in Switzerland, with informally mentored surgeons, particularly men, enjoying enhanced career progression [18]. A stark contrast was observed in a South African survey, highlighting a profound mentorship void despite recognizing its importance [19]. A needs analysis of US surgeons entering practice identified the broad themes of acquiring confidence in independent operating, integrating into a new organizational culture, dealing with bureaucracy, and balancing work and life. This work found an association between the absence of a mentoring system and adverse patient outcomes, stunted career development and higher rates of attrition from surgical practice [20]. Our work, aligned with findings elsewhere, underscores the urgent need for structured support focusing on both technical and non-technical skills during crucial career transitions. Specifically, and perhaps counterintuitively, both surgeons in transition to independent practice and trainees reported a lack of surgical mentoring compared to surgeons in established practice, reflecting the loss of a contemporary culture of formal mentoring.

The gender gap in surgery remains stark; this is reflected by underrepresentation at all levels within ESTES, in common with other surgical societies [21,22,23]]. Few female senior role models compounds the lack of mentorship opportunities for female early career surgeons and those in training. A recent scoping review showed that heavy workloads, ineffective mentorship and unclear career pathways represent further obstacles for women in surgery during the early career phase [24]. Furthermore, gender-based harassment whether personally directed or not, exerts a deleterious impact on the desirability of surgical training. The experience of our female ESTES members aligns with the existing literature, underscoring the necessity of bolstered support for aspiring female surgeons [25] and highlighting the obstacles and barriers related to gender-biased discrimination and the interplay of career with additional environmental and societal demands [25]. Increasing visibility and representation of successful female trauma surgeons through conferences, workshops, and medical professional societies can be inspirational. Moreover, providing equal opportunities for training and career advancement, addressing implicit biases in selection processes, and promoting work-life balance initiatives are key steps towards attracting and retaining more women in trauma and emergency surgery [26]. Several societies, such as Women In Surgery (WIS) and the American Medical Women’s Association (AMWA) offer academic and career progression support to female final year medical students through structured remote mentoring programs [27,28,29,30].

Traumatologists and emergency general surgeons render complex life-saving care to critically ill patients, often in a time-compressed fashion. Non-technical skills (NTS) augment a surgeon’s ability to communicate effectively, coordinate team members and manage scenarios where partial information compounds high degrees of hazard [28, 31,32,33]. While these attributes were recognized by our survey respondents, our findings reveal a discrepancy between the perceived importance of these skills and their prioritization within mentorship relationships. This gap highlights an opportunity for targeted educational initiatives from surgical societies.

The mentorship landscape in European traumatology and emergency surgery needs a strategic overhaul. Medical professional societies, such as ESTES, occupy a unique space where targeted support and innovative programs lay a path to a more inclusive, skilled, and supported European surgical community. Opportunities include recognition and closure of the curriculum and mentorship gaps in career development sponsorship, research methodology and non-technical skill acquisition support and networking and research collaboration opportunities in addition to the traditional peri-congress technical skill courses offered by such societies. To this end the yESTES, along with the Research and Educational committees, propose a strategy to bridge these gaps (Fig. 3).

Roadmap of the proposed initiatives on mentorship endorsed by ESTES within the three years from ECTES in Ljubljana 2023. Created by SPB Cioffi, MD (yESTES)

Surgical societies, especially those with a research committee, can create an environment in which international multicenter collaborative studies can be conducted [34]. Aspiring academic surgeons should be guided by experienced surgical research mentors in the refinement of a research question and the complex task of writing a scientific paper [14, 26]]. Individual shoulder-to-shoulder mentorship can be supplemented by the creation of a structured European research methods curriculum in emergency and trauma surgery, coupled to the possibility for aspiring surgeon-scientists to apply for research scholarships to fully embrace impactful research [35]. Brief intensive traveling clinical fellowship programs allow trainees and surgeons new to practice to visit host institutions for 1–3 months to acquire a particular skill and to broaden their peer and mentor networks [36,37,38]]. Funding concerns can be mitigated with strategic planning and securing grants and sponsorship support from surgical societies (such as ESTES), institutional grants, and possible sponsorships from industry partners. Such experiences have unique features that may overcome the logistical shortcomings of the different working environments in Europe, in which surgeons may not always afford to leave their workplace for an entire year, allowing them to create unique relationships with hosting surgeons and expand their support networks.

Remote career mentorship programs may also provide novel opportunities for clinical and academic development, offering flexibility and overcoming economic and cultural barriers [35, 39]]. Furthermore, extramural remote clinical mentorship programs are readily deployed, involving mentees in a productive networked relationship that supports career development, through asymmetric case-based discussion of complex surgical decision making [40]. While there is limited possibility to coach the mentee on surgical technical skills, opportunities to refine skill in perioperative management of complex cases abounds. This kind of extramural relationship could expose new surgeons to alternative clinical approaches and destigmatize requesting technical and psychologic support during the transition to independent practice [41]. Drawing from successful American models, this strategy aims to match mentors and mentees based on specific strengths and weaknesses, leading to significant satisfaction and performance improvements in identified areas [42, 43]].

One of the new yESTES initiatives is a ‘Meet the Mentors’ session at the annual society Congress, modeled on successful experiences in medical professional societies in the United States [44]. Aspiring surgeons have the chance to spend 1 h having short informal chats with senior experts in the field, exploring disparate areas of interest from work/life balance to surgical coaching, getting the unique chance to create a link with mentors as a springboard for longitudinal mentoring relationships. When the 19 mentee participants were asked to identify their priority areas for discussion with the mentors in preparation for this session, career development (15, 78.9%) was deemed as important as advice on refinement of surgical skills (15, 78.9%). Navigating the transition to independent practice (9, 47.4%), acquisition of research skills (8, 42.1%), work-life balance (6, 31.6%) and advice on how to become a good mentor (4, 21.1%) were identified as further mentee priorities.

Our survey is the first European exploration of mentorship experiences among surgeons dedicated to trauma care (visceral or skeletal) and emergency general surgery. Through capturing the opinions of a broad cohort of ESTES members, we hope it is representative of the current population of surgeons dedicated to the care of critically ill surgical and trauma patients in Europe. The percentage of women among the survey respondents (28%) mirrors their representation within the society (23%) and is broadly representative. There is the potential for a responder bias, and future work could embrace external validation of our instrument in other settings. A limiting factor could be the online nature of the survey, as ‘email burnout’ has been reported as a negative contributor to survey response rates in a recent systematic review in Annals of Surgery. Thus, a non-response bias cannot be excluded in this study [45]. We received 123 responses from 413 polled members over the two-month survey period, which corresponds to a response rate of approximately 30%. This is within the typical range for email-promulgated online surveys, where response rates can vary from 4 to 68%, with a median of 25%. Factors influencing response rates include research design, participant motivation, and researcher motivation [45].